Our Health as We Age

Physician Assistant Roger Wells met with community members at the Lexington Grand Generation Center for their morning men's coffee get together on Tuesday, September 9 to share ways to maintain health as we age.

By Roger Wells, PA-C
Lexington Regional Health Center

Indirect Influences on Health That Mean a Lot

Social Relationships

Older adults who maintain social contact, whether it be with a spouse, friends, or other outside interests, have less problems.  It lowers hospitalization and nursing home admissions.

Why?  Improved medication compliance, nutrition, physical de-conditioning, better financial and self-care (grocery, home environment, communication).

Finances

Poverty is more common among older adults than among the general population. This is despite Medicare, Social Security, Medicaid, Medicare Part D. Medicare Advantage has helped catastrophic issues but has limitations on Home Health, Physical and Occupational Therapy, Swing Bed in the post hospital stay and expensive brand name medications.

Responses to age-related changes

We have difficulty coping with the many changes that occur with aging.  This includes retirement, loss of loved ones, loneliness, and new intense burdens. These may be now required to make all financial decisions, moving to a new environment, new identified cancers, heart attacks, strokes or other limiting challenges.

In response to these challenges, successful adults become involved with new activities, social acquaintances, involvement with support groups or helping other people with similar challenges.  Most feel more valued, more energy due to the commitment of helping others and better self-esteem and interest in life.

Changes to the Body with Aging

Aging Organs

Older cells function less well as some organ cells die and are not replaced, and some are replaced but do not function as well.  It has been identified the cess of the liver, kidneys, ovaries, testes, diminish in their functional capacity.  So, medication doses, tolerance to alcohol and other substances are not tolerated as well.  The brain, however, is not one of these organs.  Healthy older adults do not lose many brain cells.  We continue to learn and develop knowledge and abilities mentally throughout our lives.

Medical issues such as strokes, ischemic events of chronic limited blood flow (as in diabetes and hypertension) minimize learning and abilities.  Alzheimer disease and Parkinson disease are examples of limiting diseases.

The first signs of age limited organs involve the eyes and musculoskeletal system.  Hearing is diminished, balance is less acute, lung capacity is less, and cardiovascular endurance is diminished.  With these issues, it is important to increase efforts in maintaining ourselves with mental, social and physical challenges to enhance these bodily functions.

Bones and Joints

Bones become less dense and therefore are weaker.  Many people develop osteoporosis due to decreased activity, malnutrition and hormone changes (decreased testosterone).  Less intake of calcium and vitamin D, especially cause nutritional deficits.  Bone stress such as lifting objects, walking and other weight bearing activities enhance bone strength and should be continued.

Cartilage that lines the end of the bones, which allows the gliding of the bone ends back and forth, loses the water and flexibility, and then are not repaired as well as when we were younger.

Ligaments that bind bones together become more rigid, making them more brittle.  Muscles become less elastic and are injured more often.  Then, they heal more slowly due to the increased stiffness and lack of reserve.

This is the reason continued activity is needed.  Activity stimulates the healing and preservation of these tissues as long as it is not excessive and breakdown is greater than the stimulus for healing.

Muscles and Body Fat

Muscle mass and strength start decreasing at about age 30 and continues throughout the rest of your life.  Some of this is due to decreased growth hormone and testosterone which stimulates growth.  Also, muscle fibers become less responsive, and we lose the “fast twitch” fibers, and the slower fibers remain making it more challenging to maintain balance and prevent falls.

We lose about 10-15% of our muscle mass and strength if we continue to stay active, and much more with a sedentary lifestyle without exercise and stimulation of the muscles and bones.

During hospitalization, and bed rest, we become extremely compromised in our ability to regain muscle strength and endurance.  We now estimate that it takes about 2 weeks of exercise to make up for each day in the hospital.  As we lose the muscle mass declines, we lose our metabolic rate as muscle mass accounts for more energy expenditure than any other component of the body.

By age 75, the percentage of body fat typically doubles compared to our young adult life.  Therefore, we need more attention to selection of nutritious foods, less calories and more water.

Eyes

Loss of Near Vision: About age 40, seeing object < 2 feet become difficult.  The lens becomes stiffened and does not respond to the muscles attempt to change the focus of the eye.  Thus, the need for reading glasses.

Need for Brighter Light: As we age, the lens of the eye becomes more dense and yellow, causing a dimming of the light entering the eye.  The retina is also less sensitive to the light stimulus. Brighter light is needed as the average 60-year-old needs 3 times the light as a 20-year-old.

Changes in Color: Because the lens turns a yellow color, the colors may look less bright and may be more difficult to see.  Blues may look gray, and other changes may occur making it more difficult to identify objects on a floor or on a counter.

Floaters: These are black specs in the eye that float around and can look like moving objects in the side of the eye.  They are made of debris or normal fluid. They are not of any concern unless they are in a huge number and have sudden changes.

Dry Eyes: The number of cells that produce fluid to lubricate the eyes become less. So, tear glands are stimulated due to dry irritation and flood the eyes with a tearing ocean of fluid.  Unfortunately, they do not contain the oily substance as do normal tears.

Ears

Hearing loss: As we all age, hearing high-pitched sounds becomes more difficult.  This is called presbycusis.  Words become harder to understand.  Women and children become more difficult to understand.  Going to a party or being in a large room can become a terrible experience.

Worse yet is the dementia associated with hearing loss.  New research has demonstrated that there is an 11% increased dementia due to hearing loss issues with aging.  Adequate hearing becomes a very important factor in preventing dementia.

Mouth and Nose

At about age 50, the ability to taste and smell start to gradually diminish.  We can taste 5 different senses (salt, sweet, sour, bitter, savory).  We lose sweet and salt more than bitter and sour.  Therefore, we add these flavors as we age.  Of course, salty, sweet flavors are not great for kidney disease or cirrhosis or congestive heart failure, and sweet needs to be restricted to prevent further diabetes issues, and creeping obesity.

Smell has been diminished in many adults after having COVID-19.  Combined with just general loss of smell as we age, we lose the general feeling of Thanksgiving, pizza, or our favorite food.

The gum around our teeth continues to recede, increasing the risk for cavities and gum infection.  Twice a day brushing and once a day flossing becomes even more important.  Infected teeth increase the risk of acute heart attacks.

Skin

Fat Layers: The skin becomes thinner and has less elasticity.  This results in more skin tears, bruising and more wrinkles.  Also, there is less cushioning of the skin over the underlying bone and muscle resulting in more injury.

Due to the less fat, the insulation also becomes less.  This will lead to more risk in cold weather and in hot weather.

Nerve Cells: The number of nerve cells diminish, therefore there is less pain, sensitivity to cold and heat, and decrease sensation to pressure.  This makes it more challenging for balance and movement also.

Sweat Glands: Sweat glands and blood vessels also diminish with aging.  Therefore, heat cannot be removed or transferred from the skin to the body or removed from skin.  This makes it more challenging for the risk of heat related injury.

Pigmentation: Melanocytes decrease in number and also decrease in the stimulation from the skin.  Large brown spots develop on the skin previously exposed to skin. This results in “age spots”.

Vitamin D Deficiency: Due to the lack of blood vessels, nerves, and response to sunlight, vitamin D deficiency results.  Vitamin D with calcium helps the body maintain bone structure and nerve function.